Rehab@home: a tool for home-based motor function rehabilitation

Purpose: This paper presents the Rehab@home system, a tool specifically developed for helping neurological patients performing rehabilitation exercises at home, without the presence of a physiotherapist. It is centred on the rehabilitation of balance and on the sit-to-stand (STS) movement. Method: Rehab@home is composed of two Wii balance boards, a webcam and a computer, and it has two main software applications: one for patients to perform rehabilitation exercises and another one for therapists to visualize the data of the exercises. During the exercises, data from the boards and the webcam are processed in order to automatically assess the correctness of movements. Results: Rehab@home provides exercises for the rehabilitation of balance (in sitting and in standing positions), and for the execution of the STS movement. It gives automatic feedback to the patient and data are saved for future analysis. The therapist is able to adapt the difficulty of the exercises to match with each patient's needs. A preliminary study with seven patients was conducted for evaluating their feedback. They appreciated using the system and felt the exercises more engaging than conventional therapy. Conclusions: Feedback from patients gives the hope that Rehab@home can become a great tool for complementing their rehabilitation process.

• Implications for Rehabilitation

• Rehab@home can be used at home by patients with motor deficits, without the presence of a therapist, as a complement to conventional therapy for accelerating the rehabilitation process.

• The system provides exercises for improving the balance and the STS movement capabilities of patients, gives automatic feedback, and saves video and load information from the movements for future analysis by the therapist.

• Its most important feature is adaptability: the therapist is able to tune the difficulty of the exercises for adapting them to the needs of each patient.

• Patients get more engaged for this type of exercises and think they can take profit from using it.

     

Perceptions of using videogames in rehabilitation: a dual perspective of people with multiple sclerosis and physiotherapists

Abstract

Purpose: Our aim was to describe experiences of using Nintendo Wii Fit? for balance exercise, from the perspectives of patients with multiple sclerosis (MS) and their physiotherapists (PT). Methods: Individual interviews with 15 patients with MS were conducted, recruited from a multi-centre study investigating the effects of balance exercising using Wii Fit. We also conducted a single focus group interview with nine PT involved in the study. The interviews were audio-recorded, transcribed, and analysed using content analysis. Results: Both patients and PT said that exercising with Wii Fit games was fun, and that it challenged the patients’ physical and cognitive capacities. The competitive content in the games provided motivation to continue playing. Patients and PT reported improved body control and, more importantly, positive effects on balance and walking in daily life. The PT regarded Wii training as an effective alternative to other balance training, but some felt unsure in how to manage the video game. The patients regarded Wii training as a possible home training solution. Conclusions: Patients with MS and their PT considered Wii Fit exercises to be fun, challenging, and self-motivating. Exercising with Wii games can address balance impairments in MS, and can be performed at home as well as in rehabilitation settings.

• Implications for Rehabilitation

• Nintendo Wii Fit? can be used as a fun and challenging way to perform balance exercises.

• The competitive content embedded in the games triggers continued playing and exercising.

• The positive effect on balance control can improve standing and walking in everyday activities.

     

Do people with intellectual disability use Nintendo Wii when placed in their home as part of a physiotherapy program? An observational study

Purpose: To examine how much, and in what way, Nintendo Wii? (Wii) is used when prescribed as part of a home-physiotherapy program for people with intellectual disability. Methods: Twenty people with intellectual disability were recruited. The following parameters were recorded about play patterns over a 12-week period: frequency, duration, perceived exertion, play position, play mode, initiation of play and games from Wii Sports and Wii Fit Plus. Results: Participants used the Wii for a median of 101?min per week (interquartile range [IQR]: 50–172) in weeks one and two across a median of three days per week (IQR: 3–4), decreasing down to a median of 35?min per week (IQR: 0–141) in weeks 11 and 12 across a median of one day per week (IQR: 0–3). Conclusions: Usage of the Wii drops off rapidly when it is placed in the homes of people with intellectual disability as part of a physiotherapy program.

• Implications for Rehabilitation

• Usage of the Nintendo Wii drops off rapidly when it is placed in the homes of people with intellectual disability and they are instructed to use it as part of a home physiotherapy program.

• Games commonly played include bowling and boxing in Wii Sport, and penguin slide, ski jump and tight rope walk in Wii Fit Plus.

• Physiotherapists should use person and family centred practice to ensure that Nintendo Wii is a suitable intervention for the person with an intellectual disability and provide support to encourage ongoing usage.

     

Musical stairs: the impact of audio feedback during stair-climbing physical therapies for children

Purpose: Enhanced biofeedback during rehabilitation therapies has the potential to provide a therapeutic environment optimally designed for neuroplasticity. This study investigates the impact of audio feedback on the achievement of a targeted therapeutic goal, namely, use of reciprocal steps. Methods: Stair-climbing therapy sessions conducted with and without audio feedback were compared in a randomized AB/BA cross-over study design. Seventeen children, aged 4–7 years, with various diagnoses participated. Reports from the participants, therapists, and a blinded observer were collected to evaluate achievement of the therapeutic goal, motivation and enjoyment during the therapy sessions. Results: Audio feedback resulted in a 5.7% increase (p?=?0.007) in reciprocal steps. Levels of participant enjoyment increased significantly (p?=?0.031) and motivation was reported by child participants and therapists to be greater when audio feedback was provided. Discussion: These positive results indicate that audio feedback may influence the achievement of therapeutic goals and promote enjoyment and motivation in young patients engaged in rehabilitation therapies. This study lays the groundwork for future research to determine the long term effects of audio feedback on functional outcomes of therapy.

• Implications for Rehabilitation

• Stair-climbing is an important mobility skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children.

• Provision of audio feedback during stair-climbing therapies for young children may increase their achievement of a targeted therapeutic goal (i.e. use of reciprocal steps).

• Children’s motivation and enjoyment of the stair-climbing therapy was enhanced when audio feedback was provided.

     

Improving fine motor function after brain injury using gesture recognition biofeedback

Purpose: We developed a gesture recognition biofeedback (GRB) device for improving fine motor function in persons with brain injury using surface muscle pressures of the forearm to provide real-time visual biofeedback. The GRB apparatus is easy to don by moderately impaired users and does not require precise placement of sensors. Method: The efficacy of GRB training with each subject was assessed by comparing its effectiveness against standard repetitive training without feedback. The outcome was measured using a nine-hole peg test (HPT) administered before and after each condition, in a cross-over study design. Results: GRB was shown to be effective for short-term improvement of fine motor function of 12 impaired participants, reducing their average time to completion of the HPT by 15.5% (S.D. 7.14%). In a subset of impaired subjects, this effect was significant in comparison to similar training without biofeedback (p < 0.05). Control subjects experienced negligible change in HPT time. Conclusions: This pilot study of a heterogeneous group shows that GRB may offer a simple means to help impaired users re-learn specified manual tasks.

Implications for Rehabilitation

• Grasp Recognition Biofeedback (GRB) is a novel technology for biofeedback in fine motor function.

• Surface Muscle Pressure in the forearm is used to record hand activity and give simple, real-time feedback.

• In a relatively small sample, training with GRB yields short-term improvements in brain-injured subjects.

     

Effectiveness of commercial video gaming on fine motor control in chronic stroke within community-level rehabilitation

Abstract

Purpose: The purpose of this study was to investigate the effectiveness of commercial gaming as an intervention for fine motor recovery in chronic stroke. Methods: Ten chronic phase post-stroke participants (mean time since CVA?=?39 mos; mean age?=?72 yrs) completed a 16-session program using the Nintendo Wii for 15?min two times per week with their more affected hand (10 right handed). Functional recovery (Jebsen Hand Function Test (JHFT), Box and Block Test (BBT), Nine Hole Peg Test (NHPT)), and quality of life (QOL; Stroke Impact Scale (SIS)) were measured at baseline (pre-testing), after 8 sessions (mid-testing) and after 16 sessions (post-testing). Results: Significant improvements were found with the JHFT, BBT and NHPT from pre-testing to post-testing (p?=?0.03, p?=?0.03, p?=?0.01, respectively). As well, there was an increase in perceived QOL from pre-testing to post-testing, as determined by the SIS (p?=?0.009). Conclusion: Commercial gaming may be a viable resource for those with chronic stroke. Future research should examine the feasibility of this as a rehabilitation tool for this population.

• Implications for Rehabilitation

• Stroke survivors often live with lasting effects from their injury, however, those with chronic stroke generally receive little to no rehabilitation due to a perceived motor recovery plateau.

• Virtual reality in the form of commercial gaming is a novel and motivating way for clients to complete rehabilitation.

• The Nintendo Wii may be a feasible device to improve both functional ability and perceived quality of life in chronic stroke survivors.

     

Cross-cultural translation and validation of the Greek version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with total knee replacement

Abstract

Purpose: Aim of this study is to assess the psychometric properties of the developed Greek version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in total knee replacement (TKR) patients. Methods: Psychometric properties of the Greek version of KOOS were evaluated according to the Consensus-based Standards Measurements Instruments (COSMIN) checklist. Patients’ pre-operative clinical status and post-operative outcomes at two occasions (at discharge and 10–12 days post-operatively) were evaluated using the KOOS, KOS-ADL and SF-12 Health Survey. Results: A comprehensive Greek KOOS was piloted and well accepted by patients and therefore administered to 60 consecutive TKR patients (mean age 72.2?±?7.2 years, 39 women). Excellent Internal consistency, good test–retest reliability of KOOS and KOOS 5 subdomains, respectively [ICC(2-1) 0.76, 95% CI?=?0.235–0.902 and 0.89, 95% CI?=?0.843–0.927] was yielded. A priori hypotheses for construct validity were confirmed with KOOS score and subdomains for pain, symptoms and Everyday Living function (ADL) correlating moderately with KOS-ADL. Responsiveness for KOOS subdomains of Pain and Symptoms yielded moderate effect size (ES?=?0.4). Conclusion: The Greek KOOS was found to be a practical and comprehensible self-reported measure for TKR patients with acceptable psychometric properties. It is therefore, recommendable for usage in future clinical trials and clinical practice.

• Implications for Rehabilitation

• The Greek version of KOOS is an essential assessment scale to evaluate not only acute injuries but also chronic knee associated conditions in a holistic perspective.

• The Greek KOOS has been found to be a practical and comprehensible self-reported measure for TKR patients with acceptable psychometric properties, recommendable for usage in future clinical trials and clinical practice.

• KOOS Greek version (downloadable at the official site http://www.koos.nu/koosgreek.pdf) was used in the validity study.

     

The provision of feedback through computer-based technology to promote self-managed post-stroke rehabilitation in the home

Abstract

Purpose: Building on previous research findings, this article describes the development of the feedback interfaces for a Personalised Self-Managed Rehabilitation System (PSMrS) for home-based post-stroke rehabilitation using computer-based technology. Method: Embedded within a realistic evaluative methodological approach, the development of the feedback interfaces for the PSMrS involved the incorporation of existing and emerging theories and a hybrid of health and social sciences research and user-centred design methods. Results: User testing confirmed that extrinsic feedback for home-based post-stroke rehabilitation through computer-based technology needs to be personalisable, accurate, rewarding and measurable. In addition, user testing also confirmed the feasibility of using specific components of the PSMrS. Conclusions: A number of key elements are crucial for the development and potential utilisation of technology in what is an inevitable shift towards the use of innovative methods of delivering post-stroke rehabilitation. This includes the specific elements that are essential for the promotion of self-managed rehabilitation and rehabilitative behaviour change; the impact of the context on the mechanisms; and, importantly, the need for reliability and accuracy of the technology.

• Implications for Rehabilitation

• To promote independent self-managed post-stroke rehabilitation in the home, feedback needs to be personalisable, simplistic, rewarding and measurable.

• Specific elements of feedback are required to achieve improved performance, confidence and self-efficacy, and the reinforcement of rehabilitative behaviour change.

• The provision of feedback through technology needs to be reliable and accurate.

     

A scoping review of video gaming in rehabilitation

Purpose: To examine the scope of the peer-reviewed literature on the use of commercially available video gaming in rehabilitation. Methods: Five databases (SCOPUS, Cochrane, PsycINFO, PubMed and CINAHL) were searched for articles published between January 1990 and January 2014. The reference lists of selected articles were also reviewed to identify other relevant studies. Results: Thirty articles met the inclusion criteria. Commercially available video gaming in rehabilitation was most commonly recommended by physiotherapists (50% or 15/30 studies) for populations at risk for falls or with decreased balance (67% or 19/30 studies). The most commonly used target outcomes were those assessing balance and/or fall prevention, with the Berg Balance Scale being the most frequently used (53% or 16/30 studies) outcome measure. The Nintendo Wii was the most prevalent gaming system (90% or 27/30 studies) used in the identified studies. Conclusion: Video gaming in rehabilitation is widely used by clinicians. Preliminary findings show that video gaming technology can be applied across a wide variety of rehabilitation populations, with some evidence showing clinical gains in physical functioning (e.g. gait and balance). There is a need for more robust clinical trials evaluating the efficacy of using video game systems as an adjunct to conventional rehabilitation.

• Implications for Rehabilitation

• Video gaming is a readily available technology that has been suggested as an enjoyable and motivating activity that engages patients in rehabilitation programming.

• Video gaming is becoming an increasingly popular adjunct to traditional therapy.

• Video gaming is most commonly used by physical therapists in a hospital setting for those with balance impairments.

• Video gaming has been shown to improve functional outcomes.

     

2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS

Abstract

Purpose: To provide a review of the 2nd International Symposium on Gait and Balance in Multiple Sclerosis (MS), emphasizing interventions in gait and balance for people with MS. Method: Review of current research on interventions used with people having MS and with people having other disorders that may provide novel insights into improving gait and balance and preventing falls in people with MS (pwMS). Results: Nine speakers provided evidence-based recommendations for interventions aimed at improving gait and balance dysfunction. Speaker recommendations covered the following areas: balance rehabilitation, self-management, medications, functional electrical stimulation, robotics, sensory augmentation, gait training with error feedback and fall prevention. Conclusions: The causes of gait and balance dysfunction in pwMS are multifactorial and therefore may benefit from a wide range of interventions. The symposium provides avenues for exchange of evidence and clinical experience that is critical in furthering physical rehabilitation including gait and balance dysfunction in MS.

• Implications for Rehabilitation

• Approaches to improve Gait and Balance dysfunction in Multiple Sclerosis.

• Balance exercises that include training of sensory strategies.

• Self-management and self-management support.

• Pharmacologic intervention, such as Dalfampradine.

• Functional electrical stimulation that may provide the extra stimulation to influence coordinated leg movements needed for walking.

     

Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit. They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p < 0.0001). Patients experienced only moderate knee pain during the strength training exercises, but knee pain at rest and knee joint effusion (p < 0.0001) were unchanged or decreased over the six training sessions. Isometric knee-extension strength and maximal walking speed increased by 147 and 112%, respectively. Conclusion: Progressive strength training initiated immediately after TKA seems feasible, and increases knee-extension strength and functional performance without increasing knee joint effusion or knee pain.

Implications for Rehabilitation

• Rehabilitation with progressive strength training initiated early after total knee arthroplasty (TKA) seems feasible.

• Rehabilitation with progressive strength training increases knee-extension strength and maximal walking speed without increasing knee joint effusion and knee pain during the first 2 weeks after TKA.

• During the progressive strength training exercises, patients with TKA may experience moderate knee pain, which seems to decrease over time. Resting knee pain before and after each training session is none to mild.

• The results of this pilot study are encouraging, but a larger randomized controlled trial, which compares rehabilitation with or without progressive strength training, is needed to confirm our findings.

     

How physical therapists instruct patients with stroke: an observational study on attentional focus during gait rehabilitation after stroke

Purpose: People without neurological impairments show superior motor learning when they focus on movement effects (external focus) rather than on movement execution itself (internal focus). Despite its potential for neurorehabilitation, it remains unclear to what extent external focus strategies are currently incorporated in rehabilitation post-stroke. Therefore, we observed how physical therapists use attentional focus when treating gait of rehabilitating patients with stroke.

Methods: Twenty physical therapist-patient couples from six rehabilitation centers participated. Per couple, one regular gait-training session was video-recorded. Therapists’ statements were classified using a standardized scoring method to determine the relative proportion of internally and externally focused instructions/feedback. Also, we explored associations between therapists’ use of external/internal focus strategies and patients’ focus preference, length of stay, mobility, and cognition.

Results: Therapists’ instructions were generally more external while feedback was more internal. Therapists used relatively more externally focused statements for patients with a longer length of stay (B?=??0.239, p?=?0.013) and for patients who had a stronger internal focus preference (B?=??0.930, p?=?0.035).

Conclusions: Physical therapists used more external focus instructions, but more internally focused feedback. Also, they seem to adapt their attentional focus use to patients’ focus preference and rehabilitation phase. Future research may determine how these factors influence the effectiveness of different attentional foci for motor learning post-stroke.

• IMPLICATIONS FOR REHABILITATION

• Physical therapists use a balanced mix of internal focus and external focus instructions and feedback when treating gait of stroke patients.

• Therapists predominantly used an external focus for patients in later rehabilitation phases, and for patients with stronger internal focus preferences, possibly in an attempt to stimulate more automatic control of movement in these patients.

• Future research should further explore how a patients’ focus preference and rehabilitation phase influence the effectiveness of different focus strategies.

• Awaiting further research, we recommend that therapists use both attentional focus strategies, and explore per patient which focus works best on a trial-and-error basis.

     

Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology

Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors.

• Implications for Rehabilitation

• Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement.

• Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise.

• The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence – key issues in rehabilitation.

• With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.

     

Reported use of technology in stroke rehabilitation by physical and occupational therapists

Purpose: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs.

Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.

Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.

Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.

• Implications for Rehabilitation

• The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.

• Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.

• Physical and occupational therapists do not widely use technology in stroke rehabilitation.

• Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

     

Women with fibromyalgia’s experience with three motion-controlled video game consoles and indicators of symptom severity and performance of activities of daily living

Purpose: Little is known of Motion-Controlled Video Games (MCVGs) as an intervention for people with chronic pain. The aim of this study was to explore the experience women with fibromyalgia syndrome (FMS) had, using commercially available MCVGs; and to investigate indicators of symptom severity and performance of activities of daily living (ADL). Method: Of 15 female participants diagnosed with FMS, 7 completed a program of five sessions with Nintendo Wii (Wii), five sessions with PlayStation 3 Move (PS3 Move) and five sessions with Microsoft Xbox Kinect (Xbox Kinect). Interviews were conducted at baseline and post-intervention and were supported by data from observation and self-reported assessment. Results: Participants experienced play with MCVGs as a way to get distraction from pain symptoms while doing fun and manageable exercise. They enjoyed the slow pace and familiarity of Wii, while some considered PS3 Move to be too fast paced. Xbox Kinect was reported as the best console for exercise. There were no indication of general improvement in symptom severity or performance of ADL. Conclusion: This study demonstrated MCVG as an effective healthcare intervention for the women with FMS who completed the program, with regards to temporary pain relief and enjoyable low impact exercise.

• Implications for Rehabilitation

• Exercise is recommended in the management of fibromyalgia syndrome (FMS).

• People with FMS often find it counterintuitive to exercise because of pain exacerbation, which may influence adherence to an exercise program.

• Motion-controlled video games may offer temporary pain relief and fun low impact exercise for women with FMS.

     

Qualitative evaluation of the SMART2 self-management system for people in chronic pain

Purpose: Technology could support the self-management of long-term health conditions such as chronic pain. This article describes an evaluation of SMART2, a personalised self-management system incorporating activity planning and review, feedback on behaviour- and acceptance-based therapeutic exercises. Method: The SMART2 system was evaluated over a four-week trial in the homes of people in chronic pain. At conclusion, participants were interviewed to understand the experience of using and living with the SMART2 system as a therapeutic tool. Results: Qualitative analysis of the interviews found that participants liked the system and reported making associated changes to their behaviour. Goal setting and feedback were the most useful elements of the system. A third key and unexpected element was that by simulating some of the functions of a therapist, SMART2 also simulated some of the process of interacting with a therapist. Conclusions: People in chronic pain may experience positive outcomes when using a self-management system designed for behaviour change. Furthermore, some of the supportive aspects of the therapeutic context can be elicited by self-management technologies.

• Implications of Rehabilitation

• Self-management technology has the potential to assist rehabilitation by supporting goal setting and providing feedback.

• By simulating some of the functions of a therapist, technology can simulate some of the process of therapy during rehabilitation.

• People in chronic pain liked using the technology in their own home and thought it could augment services delivered by clinical practitioners.

• Complex programmes of therapeutic exercises delivered by technology had limited success in engaging people in chronic pain.

     

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Purpose: The envisage programme of research was funded to explore and evaluate the use of visualisation software tools using biomechanical data within rehabilitation. Three work packages were developed to evaluate the impact of the tools within stroke rehabilitation. The research presented here aimed at exploring the perceptions of rehabilitation therapists about the use of the visualisation software tools in the context of future randomised controlled trials and stroke rehabilitation practice. Methods: Sixteen therapists working in a range of stroke rehabilitation contexts participated in semi-structured interviews. Interview questions explored their current practice, and the perceived impact of the new visualisation technologies on their workplace environment and practice. Framework analysis was used to analyse the textual data. Results: In general, the stroke therapists were enthusiastic about the potential application of the visualisation software tools. Three themes were identified through qualitative framework analysis: potential uses of the visualisation tools; integration within current service provision; and trial involvement. Conclusions: The study highlights important contextual considerations which may impact significantly on the success of novel technologies in stroke rehabilitation. Normalisation process theory was proposed as a useful process evaluation methodology to optimise both trial evaluation and future service implementation.

• Implications for Rehabilitation

• There is limited research exploring the use of visual software technologies featuring biomechanical data within stroke rehabilitation.

• The perspectives of stroke rehabilitation therapists about the potential of such tools are useful both in terms of planning trial evaluations, and implementation.

• Therapists were generally positive about the contribution of visual software tools in stroke rehabilitation, but highlighted a number of practical constraints which required addressing.

• Normalisation process theory provides a useful process evaluation methodology which can support both trial evaluation and implementation of such novel technologies within stroke rehabilitation.

     

Supporting the Loewenstein occupational therapy cognitive assessment using distributed user interfaces

Purpose: Improve the quantity and quality of information obtained from traditional Loewenstein Occupational Therapy Cognitive Assessment Battery systems to monitor the evolution of patients’ rehabilitation process as well as to compare different rehabilitation therapies. Methods: The system replaces traditional artefacts with virtual versions of them to take advantage of cutting edge interaction technology. The system is defined as a Distributed User Interface (DUI) supported by a display ecosystem, including mobile devices as well as multi-touch surfaces. Due to the heterogeneity of the devices involved in the system, the software technology is based on a client-server architecture using the Web as the software platform. Results: The system provides therapists with information that is not available (or it is very difficult to gather) using traditional technologies (i.e. response time measurements, object tracking, information storage and retrieval facilities, etc.). Conclusions: The use of DUIs allows therapists to gather information that is unavailable using traditional assessment methods as well as adapt the system to patients’ profile to increase the range of patients that are able to take this assessment.

• Implications for Rehabilitation

• Using a Distributed User Interface environment to carry out LOTCAs improves the quality of the information gathered during the rehabilitation assessment.

• This system captures physical data regarding patient’s interaction during the assessment to improve the rehabilitation process analysis.

• Allows professionals to adapt the assessment procedure to create different versions according to patients’ profile.

• Improves the availability of patients’ profile information to therapists to adapt the assessment procedure.

     

Rehabilitation of activities of daily living in virtual environments with intuitive user interface and force feedback

Purpose: To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL).

Method: A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks – door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study.

Results: The completion time of the virtual tasks decreased during the training (p?<?0.01) while the percentage of water successfully poured increased (p?=?0.051). The score of the Borg scale of perceived exertion was 1.05 (SD?=?1.85; 95% CI?= 0.18–1.92) and that of the task specific feedback questionnaire was 31 (SD?= 4.85; 95% CI?= 28.66–33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system.

Conclusions: The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL.

• Implications for rehabilitation

• Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches.

• The existing approaches focus on cognitive training rather than the manual skills.

• A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills.

• The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.